Download Trading Authority — Workplace Investing Retirement Plans

Questions? Go to Mysavingsatwork.com or call 1-800-343-0860.
Trading Authority — Workplace Investing
Retirement Plans
Use this form to grant a third party limited trading authority, which includes the ability to buy and sell securities and call Fidelity
for information regarding your account, or to provide updated information about a third party who already holds trading authority.
Do NOT use this form for 529 College Savings Plan accounts or Fidelity Personal Investing Accounts, such as IRAs. Print out and fill
in using CAPITAL letters and black ink. If you need more room for information or signatures, use a copy of the relevant page.
Helpful To Know
• For any account listed on this form that is currently
•F
ill out a separate form for each authorized agent. For
approved for BrokerageLink,SM you must submit a
business accounts, you can only use this form to grant
limited trading authority.
BrokerageLink Trading Authorization form.
• Fill out a separate form for each employer relationship for • Only the account owner can grant trading authority.
which you would like to grant limited trading authority.
• The Plan Sponsor of the retirement plan may be required
• You don’t need to complete this form for an owner —
to complete section 8 per plan rules.
the account owner already has trading authority.
• Some states limit who can have trading authority on
estate, conservator, guardian, or other fiduciary accounts.
You may want to consult a legal advisor.
1. Account Owner
Name
Address on File
Social Security Number
Date of Birth mm dd yyyy
2. Plan(s) Included
Employer Name
If there are multiple
plans for the same
plan type, then
this election will
be effective for all
those plans unless
otherwise stated.
Plan type:
403(b) Plan
401(k) Plan
401(a) Plan
457(b) Plan
457(f) Plan
415(m) Plan
3. Existing Authorized Agents
Check no more
than one.
Keep any existing authorized agents in place Default if no choice indicated.
Remove all existing authorized agents
Remove only the following authorized agent:
Name
Form continues on next page.
1.963131.100 Page 1 of 4
030570001
4. Add an Authorized Agent
Cannot be a minor.
Complete this section to grant trading authority to any individual who is not the account owner. The account owner already has trading authority. Sections 4 and 6 must be completed by the authorized agent. If you want to add an Advisory Company and Investment Advisors, skip
this section and complete Section 5.
Authorized Agent
is an individual
such as a spouse.
First Name
M.I.
Last Name
Address
Date of Birth mm dd yyyy
Social Security Number
5. Add an Investment Advisory Company and Investment Advisors
Complete this section to grant trading authority to any Advisory Company and the indicated Investment Advisors. Sections 5 and 6 must be
completed by the Investment Advisors. If you want to add an Authorized Agent, go back and complete Section 4, skipping this section.
Investment Advisory Company Name
Daytime Phone
Officer/Principal Name
Street Address
Suite Number
City
State
ZIP Code
Authorized Agent / Investment Advisor Name
Authorized Agent / Investment Advisor Name
Authorized Agent / Investment Advisor Name
Form continues on next page.
1.963131.100 Page 2 of 4
030570002
6. Authorized Agent Signature and Date
By signing below, you:
• Acknowledge that you have received a
copy of this form and the Trading Authority
Agreement, and you state that you have
read them, you understand them, and you
accept all their terms and conditions.
• Agree to be bound by the current and
future terms of all agreements, and by
any applicable disclosures, between the
account owner and Fidelity.
• State that you are familiar with and understand
the investment objectives of the account owner
and will use only trading strategies that are
consistent with these objectives.
Named authorized agent(s) must sign and date below.
•C
ertify that all information you provided is • Authorize the named authorized agents or
correct to the best of your knowledge.
investment advisors to act on behalf of the
named investment advisory company or
• Acknowledge that we may refuse to approve
organization.
you as authorized agent, or may remove you
as authorized agent from this or any other
• Agree to indemnify and hold harmless
account, at any time and for any reason.
Fidelity Investments Institutional Operations
Company from any claims, losses, or other
• Agree to act in compliance with all appliadverse consequences that may result from
cable laws and regulations.
implementing these instructions.
• Acknowledge that entities and individuals
•
Certify that the named investment advisory
who provide investment advice to others
company or organization is an investment
may be subject to regulation by federal and
advisor pursuant to all applicable state and
state regulators and agree to be responsifederal laws and regulations.
ble for determining whether and what type
of registration is required.
Print Authorized Agent or Officer / Principal Name
SIGN
Authorized Agent or Officer / Principal Signature
Date
mm-dd-yyyy
Date
mm-dd-yyyy
Date
mm-dd-yyyy
Print Authorized Agent or Officer / Principal Name
SIGN
Authorized Agent or Officer / Principal Signature
Print Authorized Agent or Officer / Principal Name
SIGN
Authorized Agent or Officer / Principal Signature
Form continues on next page.
1.963131.100 Page 3 of 4
030570003
7. Account Owner Signature and Date
The account owner must sign and date.
By signing below, you:
• Acknowledge that you have received a copy • Designate the individual(s) identified in this
of the Trading Authority Agreement, and you
form as your authorized agent(s), grantstate that you have read it, you understand it,
ing the individual(s) the ability to place all
and you accept all the terms and conditions
orders consistent with the level of trading
of the agreement, including the predispute
authority indicated.
arbitration clause, and the terms and condi• Acknowledge that we may remove
tions described in this form.
any authorized agent from this, or any
• Authorize Fidelity to act on all instructions
account, at any time and for any reason.
given on this form.
•S
tate, if signing as a guardian or conservator, that you have the power to enter into
the sales, redemptions, and other transactions of mutual fund shares, and that you
agree to execute any documents that we
may require.
• Certify that all information you provided is
correct to the best of your knowledge.
Print Participant Name
SIGN
Participant Signature
Date
mm-dd-yyyy
8. Plan Sponsor / Employer Signature and Date
Required ONLY if your plan requires Employer Approval.
By signing below, you:
• State that you are the Plan Sponsor or
Employer responsible for the Plan for which
trading authority is being requested on this
form.
• Consent to the appointment of the
authorized agent identified in this form,
understanding that:
–T
he authorized agent will be granted only
limited trading authority, as described in
the Trading Authority Agreement, and
will be authorized only to place orders
that are permitted by the Plan.
– The authorized agent is not authorized
to designate a beneficiary or establish a
new Plan.
–F
idelity Management Trust Company
acts only as custodian or trustee for this
Plan, and has no discretionary fiduciary
authority or responsibility; the account
owner, therefore, is solely responsible
for determining the suitability of, and for
accepting all consequences of, all investments and actions taken on the account.
Print Sponsor/Employer Name
SIGN
Sponsor/Employer Signature
Date
mm-dd-yyyy
Did you print and sign the form, and attach any necessary documents?
Did ALL required individuals sign? Send the ENTIRE form and any necessary
documents to Fidelity.
Questions? Go to Mysavingsatwork.com or call 1-800-343-0860
(TTY, 1-800-259-9743), business days (except NYSE holidays) from
8 a.m. to midnight Eastern time.
Unless otherwise directed, deliver to:
Regular mail
Overnight mail
Fidelity Investments
Fidelity Investments
P.O. Box 770002
100 Crosby Parkway KC1E
Cincinnati, OH 45277-0090 Covington, KY 41015
On this form, “Fidelity” means Fidelity Investments Institutional Operational Services Company, Inc., and
its affiliates. Brokerage services are provided by Fidelity Brokerage Services LLC, Member NYSE, SIPC.
654237.1.0 (06/13)
1.963131.100 Page 4 of 4
030570004
Questions? Go to Mysavingsatwork.com or call 1-800-343-0860.
Trading Authority — Workplace Investing
Retirement Plans
Customer Agreement
Purpose of Account
Terms and Conditions — Authorized Agent
This document describes the terms and conditions associated with
granting trading authority. Please review this document and keep
it for your records. Do not return it to Fidelity.
Your Commitments to Fidelity
Who’s Who in This Agreement
In this document, “Fidelity,” “us,” and “we” includes
Fidelity Brokerage Services LLC (“FBS”), Fidelity Investments
Operational Services Company, Inc., Fidelity Management Trust
Company, as the context may require. “Account owner” refers
to the registered owner of the account. “Authorized agent” is
the individual identified as such in a Trading Authority form.
Terms and Conditions — Account Owner
Fidelity’s Commitments to You
Under this agreement, we have certain rights and responsibilities. When
we accept your Trading Authority form, we are agreeing to accept
orders on your account from your designated third party — the authorized agent — according to the terms described in this agreement.
Note that we assume no responsibility for reviewing or monitoring
any investment decision or activity of the authorized agent, nor do we
provide any tax, legal, or investment advice or recommendations.
Your Commitments to Fidelity
By signing in the appropriate place on the Trading Authority form,
you, the account owner:
• Acknowledge that you have received and read this agreement,
and that you understand and agree to its terms
• Authorize us to accept instructions from your authorized agent
consistent with the level of trading authority you are granting
• Accept full responsibility for determining whether any investment
or strategy is appropriate for you, based on your investment
objectives and financial resources
• Accept full responsibility for understanding the risks associated
with granting trading authority, and assume sole liability for the
financial, tax, and other consequences of all actions and instructions of the authorized agent
Limited Trading Authority
Limited trading authority allows your authorized agent to inquire
into your account and to place orders in your account without direct
instructions from you. This may include orders to buy, sell, exchange,
convert, or otherwise acquire or dispose of securities, such as mutual
funds, annuities, and other investments.
Limited trading authority does not allow your authorized agent to
remove money or assets from your account.
Multiple Authorized Agents
If you have appointed two or more authorized agents, we will consider each of them to have the power to act alone (severally) and
without the consent of any other authorized agent, with respect to
each power granted above.
Should we receive conflicting or inconsistent instructions from your
authorized agents, we may restrict your account(s) from further activity.
Such a restriction may remain in place until we receive adequate
instructions on how to proceed. These instructions may be provided
to Fidelity over the phone or written request.
By signing in the appropriate place on the Trading Authority form,
you, the authorized agent:
• Acknowledge that you have received and read this agreement,
and that you understand and agree to its terms
• Agree to be solely responsible to the account owner for all
investment decisions, trading strategies, and instructions placed
on the account
• Agree to act on the account only as specifically authorized by the
account owner and in compliance with all applicable laws, regulations, and Fidelity policies
• Agree that we may reject or remove you as authorized agent from
this or any other account, at any time and for any reason we see fit
• Agree to notify us by calling immediately upon the death or disability of the account owner
Terms and Conditions — All Parties
Duration of Agent’s Authorization
Once granted to an authorized agent, trading authority will remain
in effect until any of the following occurs:
• We receive written notice signed by the owner withdrawing
trading authority
• We receive a phone call or written notice of resignation from the
authorized agent
• We receive notification via phone call of the death or incapacity of
the account owner or the authorized agent
• We decide, at any time and for any reason, to remove the
authorized agent
Indemnification
The account owner and the authorized agent agree that we are
not responsible for any losses you incur (meaning claims, damages,
actions, demands, investment losses, or other losses, as well as any
costs, charges, attorneys’ fees, or other fees and expenses) as a result
of any actions, or failures to act, on the part of the authorized agent.
Terms Concerning This Agreement
This agreement and its enforcement are governed by the laws of
the Commonwealth of Massachusetts, except with respect to its
conflicts-of-law provisions.
This agreement is in addition to any other agreements between the
parties and Fidelity and does not restrict any rights that may be created, either now or in the future, by these agreements or by any law.
We may amend or terminate this agreement at any time. Outside of
changes originating in these ways, no provision of this agreement
can be amended or waived except in writing by an authorized representative of Fidelity.
Fidelity may transfer its interests in this account or agreement to
any of its successors and assigns, whether by merger, consolidation,
or otherwise. You may not transfer your interests in your account
or agreement (including de facto transferral by giving a non-owner
access to the account using a username and password) except with
the prior written approval of Fidelity, or through inheritance, corporate dissolution, or similar circumstance, as allowed by law, in which
case any rights and obligations in existence at the time will accrue
to, and be binding on, your heirs, executors, administrators, successors, or assigns.
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